What is COPD?

COPD is a progressive disease where inflammation in the lungs damages lung tissue and traps air in the lungs. As the disease worsens, it takes longer and longer to exhale. The lungs become overinflated and shortness of breath develops. Inflammation is most often due to cigarette smoking. Once started, the inflammation is difficult to stop.

How COPD Affects Your Body

Inflammation in the lungs causes damage to the airways (breathing tubes). It narrows the small airways and increases mucus secretion. There is also inflammation in alveoli (air sacs) that damages lung tissue. This makes it harder to get oxygen into to the body and remove carbon dioxide. The inflammation leads to increasing shortness of breath and limits your ability to do things like housework and climbing stairs. The lung damage normally gets worse slowly but unpredictable exacerbations (or disease flairs) can occur. They are often triggered by infections. These COPD flairs can rapidly increase your symptoms. If severe, you can end up hospitalized.

How Serious is COPD?

COPD can range from a mild to a severe disease. COPD is progressive. With time, shortness of breath worsens. It becomes harder to exercise and even daily activities can be difficult. COPD also causes cough, chest tightness, wheezing and chronic phlegm (or mucus) production. Severe disease can lead to weight loss and fatigue. Depression, thin bones, lung cancer, heart disease and muscle weakness are all more common in people with COPD. It can also cause severe disability and even death. COPD costs the United States 50 billion dollars a year in lost wages and medical bills. It is the 3rd most common cause of death. Twenty four million people in the United States have COPD and half don’t even know it. Stopping smoking can slow down the progression of lung disease.

COPD Symptoms, Causes, and Risk Factors

Not all smokers develop COPD. The risk is about 20 to 25 % and increases with the amount smoked. Smoking increases the risk of getting many diseases in addition to COPD, including lung cancer and heart disease. Symptom overlap. COPD can easily be mistaken for other diseases including asthma, chronic lung infections, and heart disease. This is particularly true during the early stages of COPD. Most people with COPD start having symptoms in their 50s and 60s. A small number who have an inherited form of COPD (Alpha-1) can have symptoms at a much earlier age.

Symptoms of COPD

COPD is normally slowly progressive. Symptoms are usually mild at the start but get worse, particularly if smoking or irritant exposure continues. The most common symptoms are:

Weight loss, poor appetite, weakness and fatigue can be seen with advanced disease.

Causes of COPD

No one knows why some people get COPD and others do not. There are probably many factors leading to the damage to lung tissue seen in COPD. Some of the factors are environmental exposures and some are genetic. Others are related to childhood illnesses and early lung growth. Some known risk factors are listed below.

Risk Factors for COPD

Exposures:

Cigarette smoke is the best-known and most important risk factor. Both smoking and second hand exposure, as well as other types of tobacco smoke are linked to COPD. The more the exposure to tobacco smoke, the higher the risk of getting COPD.

Some dusts and fumes in the workplace

Indoor air pollution from burning wood and coal as fuel for heat and cooking is an important risk factor worldwide

Genetics:

Alpha-1 antitrypsin deficiency is an uncommon inherited condition that greatly increases the risk of getting COPD. People with Alpha-1 make a defective protein that normally would protect the lung from damage.

There are other poorly understood inherited factors that also increase the risk of developing COPD.

Early lung infections and other conditions that limit normal lung growth in childhood

When to See Your Health Care Provider (HCP)

You should be evaluated for COPD if you have ongoing problems with any of the symptoms listed above. This is particularly important if you are a cigarette smoker of have a family history of COPD at an early age (before 50). If you already know that you have COPD, you should contact your health care provider if your symptoms worsen despite treatment.

Diagnosing and Treating COPD

Diagnosing COPD requires a careful history and exam by a health care provider (HCP). It also requires testing lung function. This can normally be done by a primary care provider. In difficult or severe cases, it may require an evaluation by a specialist.

The diagnosis of COPD requires an appropriate history AND a breathing test showing problems breathing out completely. Breathing tests can also be used to assess the severity of COPD. Additional tests may be needed to exclude other diseases that can cause similar symptoms.

How is COPD Treated

The most important step in treating COPD is removing the cause of the lung inflammation. For most people, that is cigarette smoke. While there is no good way to repair the damaged lung, stopping smoking can slow the loss of lung function. It also helps prevent diseases flairs. All patients with COPD who smoke need to stop! They should ask their HCP for help with quitting. Medicines can help with many of the symptoms of COPD and treat disease flairs. Many COPD medications are taken using an inhaler. This helps increase the amount of medication that gets to the lungs. There are several types of medications that can help treat COPD. Often, more than one medication is combined in one inhaler. Types of medications include:

Bronchodilators – these medicines work by relaxing muscles in the airways to make it easier to exhale. There are two types based on how the drugs relax the muscle, beta agonists and anticholinergics with both long and short acting versions of both. Each type works differently and they can be combined.

Steroids – Steroids are medications that reduce inflammation in the lung. Steroids can be given orally, intravenously (IV) or by inhalation. IV and oral steroids are helpful in treating acute flairs of COPD. Their side effects make them difficult to take chronically. Inhaled steroids can help manage COPD in certain patients. They are often combined with long acting beta agonists in one inhaler.

Phosphodiesterase-4 inhibiters – are oral anti-inflammatory medicines that can decrease exacerbations in patients with more severe COPD.

Antibiotics – are sometimes used to treat exacerbations. One type of antibiotic might be helpful as a daily treatment in some patients with more severe disease and frequent exacerbations.

Lung volume reduction surgery – involves removing damaged lung tissue so that the remaining lung can work better. It can help a small number of COPD patients.

Transplantation can help some patients with very severe COPD.

Living with COPD

Patients with COPD face many challenges. COPD is a chronic progressive disease and can interfere with many aspects of a person’s life.

What to Expect

COPD normally worsens slowly but can involve unpredictable flairs. These flairs can further damage lungs, increase dyspnea, and reduce exercise capacity. There is a wide variation in how quickly the disease progresses. In many patients, COPD can get to the point that it severely limits activity and reduces quality of life. Other diseases like heart disease, depression, anxiety and osteoporosis are common in patients with COPD and can also affect quality of life. Early diagnosis and taking control of the disease can help minimize its effect on your life.

Managing COPD

There are many things that you can do to reduce the impact of COPD on your life.

Stop smoking and do not allow others to smoke around you. This slows the progression of the disease and reduces the risk of exacerbations.

Stay active. Twenty minutes of moderate exercise three times a week helps reduce the risk of heart disease, decreases shortness of breath and improves your well-being. If you are unable to do 20 minutes of exercise or if you can’t do your normal activities due to shortness of breath, ask your HCP to send you to pulmonary rehabilitation.

Eat a healthy diet and maintain a normal weight.

Educate yourself about your disease and treatment options. Know when you need to contact your HCP. Have a plan for dealing with exacerbations.

Take your medications. Many of the medicines used to treat COPD are expensive and there are not many generic substitutes. If you can’t afford your medicine, let your HCP know. There are programs that may help you cover the cost of medication.

If your COPD is moderate to severe, talk to your family and HCP about your wishes for end-of-life care. Knowing what is important to you will help your HCP and family care for you as the disease progresses.

There are many places to get support dealing with COPD. There are both local and on-line groups that can help you find answers to your questions and provide assistance. Your HCP will likely know the support groups in your local area. Other on-line resources are listed below:

For Health-Care professionals:WipeCOPD
WipeCOPD is an acronym for Web-based Interactive Professional Education in Chronic Obstructive Pulmonary Disease. This program was developed with the help of an educational grant entitled the “GlaxoSmithKline Distinguished Scholar Award in Respiratory Health” from the CHEST Foundation, the philanthropic arm of the American College of Chest Physicians.

Questions for your Health Care Provider:

Do I have COPD?

This sounds like a simple question but many diseases can be confused with COPD, especially Asthma. Some patients have features of both Asthma and COPD. This is called Asthma-COPD Overlap Syndrome. Patients with this syndrome should see a lung specialist since they tend to have more problems than patients with either Asthma or COPD.

How severe is my COPD?

Health care providers use breathing tests and the GOLD classification system to grade COPD severity. While the scoring system can be helpful, COPD symptoms don’t always correlate with the breathing test severity. The more important question to ask yourself and to discuss with your HCP is, “How does COPD keep me from doing what I want to do?”

Am I up to date on my immunizations?

Preventing infection is important for patients with COPD. Patients should be up to date on all immunizations, but should pay particular attention to influenza and pneumococcal vaccinations. Current recommendations are that patients with COPD should receive yearly flu shots and both pneumococcal vaccinations. While there are several flu vaccines, a specific one isn’t recommended. The important thing is to get vaccinated.

What are the side effects of my medications?

This is an important question. Your HCP should review how to take all new medications and the possible side effects. You should ask if there are any interactions with your other medicines and if there are side effects are serious enough for you to stop the medicine.

What should I do if my breathing gets worse?

You should know what to do if you have an exacerbation and when you need to be seen. Ask your HCP what you should do when the office isn’t open if you need help.

What should I do if I am traveling? Do I need oxygen for an airplane flight?

Traveling can create challenges for patients with COPD. Patients traveling should make sure that they have enough medication for the trip and take in their carry-on bag if flying. All patients using oxygen will need it when flying. Some patients who don’t normally use oxygen will also need it on an airplane. Your HCP can tell if you will need oxygen based on some simple office tests. You will also need to notify the airline. If you need oxygen at your destination, your oxygen supplier will need to arrange this in advance.

I can exercise by myself. Why do I need to go to pulmonary rehabilitation?

Pulmonary rehabilitation is more than just exercise. There is education that can help patients with COPD. Exercise in pulmonary rehabilitation is monitored by medical professionals and you are less likely to stop exercising if you do it with a group.

Do I need a nebulizer?

Nebulizers convert liquid medicine into a mist that can be inhaled. Most patients with COPD don’t need nebulizers but they can help some patients who have difficulty using inhalers. There are several disadvantages to using nebulizers. It takes extra time to deliver the medicine. Nebulizers are less portable and require cleaning. Not all medicines can be given with a nebulizer. Nebulizer medication doses are also much larger than those in inhalers, so the risk of side effects is higher. You should talk to your HCP about a nebulizer if you are having problems using inhalers.

Oral steroids help my breathing when I have a flair. Why can’t I take them chronically?

Oral steroids can help with acute flairs but have many side effects, including infections, muscle weakness, fractures and worsening diabetes control when used over a long time. Oral steroids have not been shown to help most patients with stable COPD and are not recommended for chronic use.

Should I have a lung transplant?

COPD is the most common reason for a lung transplant. Lung transplants can improve survival and quality of life in some patients with end stage COPD but there can be complications. After a lung transplant, you need to take medication to keep from rejecting the transplant. There is a limited supply of lungs for transplants and not everyone with COPD is healthy enough for surgery. Transplants are normally done when a person has less than two years to live but it can be difficult to predict how quickly COPD will get worse. If you think you might be interested in a lung transplant, ask your HCP to send you to a transplant center for testing.